Web viewBlank or dark areas in field of vision. Poor night vision. Figure 3: Normal Vision Figure 4:

Welcome to CNIB’s InFocus Webinar Series Webinar 1: Diabetic Retinopathy Basics Presented by: Netan Choudhry M.D. FRCS(C)

Date: 25th October 2012 Start Time: 1:00 pm EST

CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 2: Diabetic Retinopathy Basics: Objectives

Participants will be able to learn about:

Anatomy of the eye What is Diabetic Retinopathy Signs and Symptoms Types of Diabetic Retinopathy Risk Factors and Prevention Diagnostic Tests Treatment Frequently Asked Questions

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 3: The Anatomy of the EyeThe Retina – senses light and transmits images to the brain

The Macula – central part of the retina used to read and see fine details clearly

The Vitreous – clear gel fills the back of the eye and sits in front of the retina

Figure 1: The Human Eye

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 4: What is Diabetic Retinopathy?Occurs when elevated blood sugar levels cause blood vessels in the eye to swell and leak into the retina.

Figure 2: Diabetic macular edema (swelling of the retina)

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 5: Signs and Symptoms

Floaters Blurred vision Fluctuating vision Blank or dark areas in field of vision Poor night vision

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Figure 3: Normal Vision

Figure 4: How vision may be affected by diabetic retinopathy

CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Vision loss

Slide 6: Types of Diabetic RetinopathyEarly stages:

Non-Proliferative Diabetic Retinopathy (NPDR)

Damaged blood vessels in the retina begin to leak fluid and small amounts of blood and cholesterol.

Mild NPDR may not necessarily affect vision. Results of blurred vision:

Figure 6: Fluorescein angiogram of macula edema Figure 5: Macula edema

Fluorescein dye leaking in macula

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 7: Types of Diabetic RetinopathyLate stages:Proliferative diabetic retinopathy (PDR) Retinal vessels close causing significant reduction in blood flow. The retina responds by growing new abnormal vessels. Can affect both central and peripheral vision. Vitreous hemorrhageNew blood vessels bleed into vitreous cavity.Tractional retinal detachment Scar tissue can shrink causing the retina to detach and result in vision loss. More severe vision loss occurs if the macula is detached.

Figure 5: Macula edema Figure 6: Fluorescein angiogram of macular edema

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 8: Risk Factors/Prevention

Uncontrollable Diabetes type Ethnicity

Controllable High blood sugar Smoking High blood pressure High cholesterol Obesity

Early detection via eye exams is paramount

Figure 7: Tractional retinal detachment

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Figure 8: Fluorescein angiogram

Figure 9: Optical coherencetomography (OCT)

CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Type 1 diabetes: within 5 years of diagnosis, then annually

Type 2 diabetes: at time of diagnosis, then annuallyGestational diabetes: within 1st trimesterSlide 9: Diagnostic Tests

Basic assessment Visual acuity test Tonometry: Measures pressure inside the eye

Dilated eye examAdvanced assessment

Fluorescin angiogram: dye is injected systemically which demonstrates retinal circulation

Optical coherence tomography (OCT): non-invasive imaging study that reveals retinal anatomy

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Figure 10: Laser photocoagulation

CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 10: Treatments

Proliferative retinopathy

Laser surgery• Microscopic thermal laser burns are made in the retina• Shrinks and prevents abnormal new blood vessel growth,

and stops leaking of blood vessels• Can reduce risk of further vision loss by 50%• Also recommended to treat macular edema

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 11:TreatmentsProliferative retinopathy

Intraocular (anti-VEGF) injections• Reduces swelling in the retina and causes abnormal

vessels to regress

Figure 11: Intraocular injection

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 12: Treatments

Diabetic macular edema

Lucentis

• Health-Canada-approved anti-VEGF treatment• Approved for reimbursement in Quebec only

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 13: TreatmentsAdvanced proliferative retinopathy

Vitrectomy

• Cloudy vitreous is removed and replaced with a clear solution that mimics the normal eye fluids

• Allows light rays to focus on the retina again

Figure 12: Pars Plana Vitrectomy

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Slide 14: Eye Connect: Diabetic Retinopathy

cnib.ca/dr- Diabetic retinopathy basics- Prevention- Diagnosis and treatment- Living with diabetic retinopathy- Health care professionals’ page- Patient guide

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Final - Slide 15: CNIB Contacts and Resources

• CNIB website: cnib.ca• Toll-free

CNIB Helpline: 1-800-563-2642

• Email: info@cnib.ca

Production of this material has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics

Web: cnib.caEmail: info@cnib.caCNIB Helpline: 1-800-563-2642

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